Publications

BACKGROUND

Primary care physicians care for reproductive-aged women, yet do not routinely counsel women about or prescribe contraceptives, including emergency contraception (EC).

STUDY DESIGN

We used a pre-/post-study to design to assess whether the proportion of primary care physicians who counseled women about and prescribed EC increased 6 months after a peer-led intervention with educational and reminder components. Participants included 36 residents and attending physicians at an academically affiliated internal medicine practice from July 2004 to June 2005 (when prescription was required for EC in New York). Data were collected by self-administered questionnaire.

RESULTS

At baseline, 37% of participants had counseled women about EC and 34% had prescribed EC in the prior month. After the intervention, 80% of participants had counseled women about EC (p<.001) and 66% had prescribed EC (p=.03) in the prior month.

CONCLUSION

Six months after a peer-led intervention including educational and reminder components, the proportion of primary care physicians who had counseled women about and prescribed EC in the past month increased significantly.

AIM

Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH).

DESIGN, SETTING AND PARTICIPANTS

A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months.

INTERVENTION

A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care.

MEASUREMENTS

An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use.

FINDINGS

Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition.

CONCLUSIONS

A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.

The Fatigue Symptom Inventory has been used extensively to assess and measure fatigue in a number of clinical populations. The purpose of the present study was to further establish its utility by examining its operating characteristics and determining the optimal cutoff score for identifying clinically meaningful fatigue. The MOS 36-Item Short Form Vitality scale, a measure widely used to identify individuals with significant fatigue-related disability, was used to determine the sensitivity and specificity of the Fatigue Symptom Inventory. Results indicate that a score of 3 or greater on those items assessing fatigue in the past week is the optimal cutoff score for identifying clinically meaningful fatigue. Individuals who scored at or above the cutoff also reported significantly greater fatigue interference, more days of fatigue on average, and fatigue a greater proportion of each day in the past week. Findings suggest that the Fatigue Symptom Inventory can be used to discriminate effectively between individuals with and without clinically meaningful fatigue.